Pharmacy's Path Forward | Bruce Kneeland, BA Mktg & PR, Independent Pharmacy Specialist

Speech to text:

Mike Koelzer, Host: [00:00:00] Bruce for those who haven't come across you online, introduce yourself and tell our listeners what we're talking 

Bruce Kneeland, BA Mktg & PR: about today. My name is Bruce Kneeland. I help people who own pharmacies do more and be better is kind of my tagline. Perhaps the most notable thing about me is I get to go visit remarkable pharmacies, chat with the owners, find out a little bit about what they're doing and that I write about them for some pharmacy journals.

And you know, fortunately for me over the last couple of years, I've become a podcast. You're just like you. I do a program called pharmacy crossroads, and it's a member of the pharmacy podcast network. I'm proud to be associated with that organization. I'm thinking today, I'd like to explore just a number of things that I think it takes for a pharmacy to be successful in today's age.

You know, how do you compete? Uh, how do you manage, you know, what do you need to do in order to stand out from the competition? 

Mike Koelzer, Host: Bruce, the only person that I think would have a cooler job than you would be that guy, I don't even know how to say his last name. He's got the spiked hair he's on the food network.

He does the drives and you know, the diver w what the hell 

Bruce Kneeland, BA Mktg & PR: is drive-ins and dives or whatever. Yes. 

Mike Koelzer, Host: Because what a great thing they got going. I mean, I'm sure he has more, but in theory, he could have a team of like two, you know, the videographer and then himself. I mean, he gets to go there and pick out, you know, he gets to go there and eat when he's done with it.

Yeah. That's such a cool thing. Your crossroads thing, when's the first time you packaged it as either a blog or a podcast 

Bruce Kneeland, BA Mktg & PR: thought? Well, uh, the podcast things started just with the beginning of COVID in, quite frankly with COVID I wasn't able to get on the road and go anymore. So, uh, you know, that's when the podcast thing came around.

So 

Mike Koelzer, Host: when you went there, you weren't recording your visits only with COVID. Did the benefit of turning this into a 

Bruce Kneeland, BA Mktg & PR: podcast com? Uh, absolutely. So the road trips, uh, and I'm a low tech guy, so, um, you know, I'm, I'm embarrassed to say that, but the road trip, the first road trip I took as a formal organized sponsored thing was in 2012.

And, and that's as simple, as simple and as complicated as I found a sponsor, somebody who would pay for this, I got America's pharmacist magazine to agree. Cover the road trip. Um, and then my wife and I jumped in a car and we drove from New Jersey to San Francisco and by appointment and by careful selection, uh, visited 30 pharmacies along the way.

And then I wrote about. Uh, for the magazine and then did probably six or seven CE programs on that, uh, back in 2012. And since then, I've done a leaven more, uh, nowhere near as complicated as the first, but, um, it's just been, uh, it's just been a great experience. It's amazing what you can learn when you go in and sit down to talk to a pharmacy owner and you have nothing to sell and no agenda.

And you just say, Hey, you know, what are you doing here? How did that happen? And how's it working for you? And, um, and I just Marvel at the innovation that independent pharmacies come up with in order to find a way to make some. 

Mike Koelzer, Host: We could have entitled this, like the world's greatest salesman, because I wish I had the tenacity or the forethought to call up people and say, Hey, do you want to pay for my cross-country vacation?

That takes some guts to do that. That's cool. And then secondly, you're like the cool young people on Instagram who like to get these vans and go across the country and all their posts pay for that. So you're 

Bruce Kneeland, BA Mktg & PR: way ahead of your time. It's a fascinating story there. Mike, the first one was the hardest, uh, which is always the case.

So, you know, I came across the idea that the idea came, I read a time magazine article, um, you know, I think. 1996 or whatever, where they put some editors on the road, us route 50. And they went all the way across the country and visited small towns. And I said, Hey, that's a great idea. " Some day, I'm going to try to pull that off.

So the first one, um, was the hardest. I pitched 15, 16 companies finally through a friend. I pulled in a favor and I came up with, you know, 10, $12,000 to do this. So that came out and then the next time I wanted to do it, I hit 12 companies at the same time and said, Hey, the [00:05:00] first one who responds, gets to do it.

And I had a commitment in 12 hours. Wow. So the pattern hit, it captured, uh, it captured a vein. And, um, and I will confess now because I'm not trying to get any more sponsors, but after the second one, it did become a way to take a vacation and go someplace that we had always wanted to go. The third trip was actually route 66, my wife and I flew to Chicago and drove all the way to Santa Monica and did route six, six, and we'd always wanted to do that.

And it's just been one of the luckiest things that a guy ever fell into because it, it just kind of fed on itself. You do the road trips, you write the articles, you do the CE programs, and then people start to think you're smart. Um, and so then I had companies who would pay me to do things like that. And here I am.

10-12 years later. And, uh, I just, just did my last one last fall on that 

Mike Koelzer, Host: first one where you like already going and you said, Hey, I might as well put some cool marketing to this, or would you not have gone if the. Sponsorship wasn't there because you had to be doing something else to raise money for your family.

And so on. Did those truly coincide that you did need sponsors before you hit the 

Bruce Kneeland, BA Mktg & PR: road? Yeah, it was a commercial venture from the start, so yeah, I, I, I needed to find a sponsor to pull it off and was lucky, lucky to be able to get. How long was the first one, the first one was way too aggressive because we were stupid and didn't realize all that was entailed.

But, uh, we took that trip in 13 days, um, and, uh, drove, you know, 4,700 miles. As I recall, the mileage is not the critical deal, but we tried to fit too many pharmacies per day. Uh, you know, I had to get 30 pharmacies. So there were days that we did three, um, you know, you had to lay them out so that, you know, you hopscotched or leapfrogged over one to the other.

I just made some great friends, met pharmacies. I had never seen or met before. And it just worked out, worked out exceptionally well. 

Mike Koelzer, Host: What would your game plan have been? You did not get those sponsors, would you have figured it was not the right time or just 

Bruce Kneeland, BA Mktg & PR: not done it without a sponsor? It never would have happened.

Um, you know, I, I mean, if for the, for our listeners, some of them may recall that I, you know, there was a time when I had a real job. So, um, I had been with Amerisource, uh, prior to their merger with Bergen Brunswick. And, um, when Amerisource and Bergen merged is when I lost my job. Um, I had been the vice president of retail sales and services at Amerisource and, uh, loved what I was doing and had no desire to be an entrepreneur.

But, um, when they, uh, when they cut me loose after the merger, uh, You know, I, I became a consultant and I just started doing odd jobs and trying to find things to do. And, um, you know, uh, seven or eight years into that consulting gig, this thing came up, but, you know, I needed to hustle and find companies to work for.

So, uh, you know, it was, um, you know, I've been lucky that I've never missed a paycheck, but I, um, you know, I've, I've probably done projects for 14 companies over the last 10 years, 

Mike Koelzer, Host: You know, with Amerisource all this time. And most people see a merger as a good thing. You know, we were with Bergen Brunswick and all of a sudden we hear the Amerisource name come in, you know, years ago, never thinking that Bruce is on the street because of it, as you think back to those days, Uh, merger coming.

And you being the victim basically of a merger, did you feel like a victim? Was it nerve-racking, was there anger or did you see it as an opportunity? And I don't mean to stack that question because I don't want you to say it's an opportunity if it wasn't truly, how did you feel 

Bruce Kneeland, BA Mktg & PR: about it? Um, uh, is it okay to say the word pissed on the air?

Heck yeah. Um, no, it hurts hard. It's a gut punch. Uh, And I've been through that twice in my career and it, it, it hurt both times. Um, and, uh, you know, I, I, you know, I will confess, you know, it's 20 years ago now. And, um, you know, I run into people who, uh, uh, who were part of that organization and, you know, we keep a friendly relationship.

I understand it's just business. Um, but it hurt and, uh, [00:10:00] Fortunately at that level, you know, they soften the blow by, you know, giving you a severance package and that kind of stuff. So I had a, uh, a runway to start something on my own, but my first reaction was to go out and try to find another job. And, um, you know, I had had a pretty successful career in the drug wholesaling arena.

And, uh, there were companies that I interviewed with, fortunately, none of those worked out because two or three years later, those companies were swallowed up. So, uh, it was, it was a good thing. And my wife, you know, told me that, you know, we've moved a lot, I've got five kids and, you know, we've had kids live in six different states and, and, uh, I was, you know, interviewing for your job that would have moved me to Illinois or job that would have moved me to Texas.

And my wife said, you can go, but I'm staying. So, uh, we, uh, we invested a little bit and. Office furniture. And I took over a daughter's room who had moved out and got married and had a corner office with windows on both sides and set myself up as a consultant. And without a plan, uh, it's worked out remarkably well, 

Mike Koelzer, Host: Bruce, when you say pissed was that one of those situations where you're upset with what went down in that merger and you losing your job, but you really had nobody that you could pinpoint because it's such a big operation or without naming names where they're actual people that you are thinking, well, why the hell did Tom do this?

Or why did Sally do this when such and such? I mean, was there anybody who could have received that feeling from you or was it all nebulous? Because the organizations were getting so bad. 

Bruce Kneeland, BA Mktg & PR: Yeah. Th you know, that's, it's an interesting thing. It is clearly nebulous. And to the point, the, uh, the gentlemen who, you know, had to give me my release really was a very good guy and very competent, very capable.

And, he was trapped by the nature of the merger. Um, you know, Amerisource was a pretty big company. Bergen's is a pretty big company. They go to three different markets. You know, we had an independent chain and hospital. I was responsible for the independent sales at Amerisource, and, and as the merger came together, um, the Bergen people basically took over the.

The retail part of the business and the Amerisource people took over the hospital side of the business and I was retail. So, you know, so I was gone, um, and you know, intellectually, that all makes sense. And you, you know, when you're putting a company of those sizes together, that you're part of the reason they do it is because they can eliminate a third of the senior management over it.

So I got caught up in that, 

Mike Koelzer, Host: But our pharmacy, my dad, had always run a store that was growing. I mean, from the time that he took it over from his dad and the way pharmacy was in the last 50 years of the 20th century, things were kind of always on an up climb. And my dad had a handful of enemies. I could count on one hand, the people that he talked poorly about.

Part of that was because maybe he was a good guy, but part of it also is because the business had stresses, but one of the major stresses wasn't the shrinking of the business. You know, it was always expanding, but I learned quickly, like five years ago, that when a business isn't expanding, when it's shrinking, there's a lot more that maybe was brewing under hundred dollar bills.

When those hundred dollar bills are gone and things are getting tough. A lot of different personalities come out. A lot of anger, a lot of stuff comes out and in my little business, It's really easy to see, but I think about these bigger businesses, how nebulous these things are. And it's kind of like, I don't know if it's better to see the monster and know the monster, me being the monster some of those times.

And sometimes maybe my staff, I don't know if it's better to see that, or just have a nebulous organization that you're a victim of. 

Bruce Kneeland, BA Mktg & PR: I think that translates into what we see in the industry today. I mean, when sales are growing, everybody's happy. Everybody's happy when, when things start falling apart, you know, fingers start getting pointed at and.

People react differently under different stressors. You know, we keep talking to pharmacy owners, you've got to change, you've got to improve, you've got to do this, this ad or whatever. And, and [00:15:00] even now I realized that I can say it, but it's hard for me to do it. So, you know, when I think about advice that I want to give to pharmacy owners, it's almost always about thinking about how you are going to attract more customers and fill more prescriptions.

And that's the mindset that at least, you know, you and I have lived with for 50, 60 years as we've digested the business. And, that's just not the way to succeed anymore. It's just hard to break out of that mode. I mean, automatically when somebody talks to me and they want advice, I automatically think about how do you get more customers and fill more prescriptions?

And, you know, I see people now who are cracking the code and doing things differently. And you know, that clearly what happened in the wholesale drug industry, um, and you know, they've an order to grow. They bought other wholesalers and, you know, rolled it all up and, and things were great. But those days are over for the wholesalers as well.

There ain't any more mergers coming. Um, they've all swallowed each other as much as they can. I mean, there's a little one here, there that may happen, but nothing that's going to be material to the marketplace. 

Mike Koelzer, Host: Remember the yellow pages used to be a yellow page ad and it was on TV of all things. They asked this guy why he wasn't, it was a commercial why he wasn't advertising in the yellow pages.

And his answer was, well, I might sell my lash rug and then I'd be out of business. But with pharmacy years ago, I would ask my. Do I want to advertise for, let's say delivery. Do I want to advertise for that? Because it's more money and if I'm going to advertise for it, how far out around the pharmacy do I want to advertise it?

That kind of thing. What's the radius? But the point you're alluding to there is in today's economy and pharmacy with these pharmacy benefit managers slash insurance is paying below cost. Now that comical question of do I want customers to come in? It's like, that's a true question. Now, do you want more customers?

It's like, it depends. And, and that's what you're saying. Bruce's like, it used to be a little, maybe a little easier for marketing people to say, well, here's your answer. Get more customers, you know? And now it's like that can put you in the 

Bruce Kneeland, BA Mktg & PR: hole in a hurry. We got to figure out a new revenue source. 

Mike Koelzer, Host: Put yourself back 20 years ago, when you lost your Amerisource job, what would your thought have been somehow getting a crystal ball shot of where we were going to be in 2022?

What would your feelings have been that day? If you could have looked out 20 years, 

Bruce Kneeland, BA Mktg & PR: 20 years ago, if I was sitting here looking at a pharmacy industry where routinely you're selling expensive drugs below cost and 20 years ago, all I could have imagined was Fillmore, Fillmore, Fillmore. Um, I, I couldn't have seen that there are avenues of going forward.

So 20 years ago I would have looked for a different way to go. I need to say now, boy, am I glad I didn't see 20 years ago? Because I see there are ways to go. The beauty of this business is. First of all pharmacists need to understand that they are not pharmacists, they're healthcare professionals and the pharmacy business is eroding because the business model is eroding, but the healthcare business is exploding.

Um, and, and the more we can grasp onto the fact that we're healthcare providers, your healthcare providers, I can't wear that mantle, that the best analogy that I have come up with, and I have been preaching this in my CE programs for 10 or 12 years is to go back to 1903. When the Wright brothers flew the first airplane.

At that time, the quickest way to get rich was to railroad most. The railroads were exploding. They were growing in you. You've got millionaires being made all the time by lane track across the country. 20 years later, the airplane starts to become something significant. And the railroad people continued to build railroads.

But you look at who knew how to sell tickets, who knew how to build terminals, who knew how to maintain schedules, who knew how to maintain complicated equipment. They thought they were in the railroad business, not the transportation business of a pharmacist, and understood their healthcare providers.

There's no end to where they can go. 

Mike Koelzer, Host: 20 years ago, you looked out and said, it's going to [00:20:00] be so terrible and it's going to be terrible for everybody, but really. That puts you in a good spot because you're more needed than ever as a consultant. Going along with the flow, maybe you would not have been needed as much as you are now.

Bruce Kneeland, BA Mktg & PR: The problems are opportunities in disguise. I hadn't thought of it in that direction. And I'm, I'm glad you did. Um, you know, the fact of the matter is yeah, the changes necessary and the companies that have come along that provide some of those changes have been the backbone of where I've, uh, made my income over the last 20 years.

So that's an interesting observation. 

Mike Koelzer, Host: You look now at the population dying from heart disease and cancer. Arguably, cancer's kind of a dumb luck, but sometimes it's different things we can do, but you look at all the needs out there and there. A huge opportunity for healthcare as you preach is just going to be different tactics.

Bruce Kneeland, BA Mktg & PR: Let's step back and define what health care is. Most of us are, are, you know, modern medicine oriented. So when we think healthcare, we're thinking doctors and hospitals and, you know, in pills, but, um, you know, you look at what's happened with health care and it's it's food. Um, it's, you know, it's exercise. I can't even think of some of them.

You know, things like acupuncture and, and, you know, those kinds of areas that, you know, the people are gravitating towards. Um, and it's, it's just a lot of opportunity. Um, you know, pills and bottles are, I, I want to go on record as saying, I think a pharmacy, at least the average kind of mindset of a pharmacy needs to be filling a lot of prescriptions.

Uh, I'm not one of those who thinks the profession should take, give up on the pills, uh, that is your foundation. And as you're going to work into other areas of healthcare, whichever might appeal to you emotionally or intellectually. You're going to have a percentage of your patients who are going to be interested in that.

So you want to increase the number of patients you have, as much as you can, so that the small percentage of people who are going to be interested in weight loss programs are, you know, are, are going to be enough to justify the investment in a weight loss program. If you're going to get interested in massage or acupuncture, I see no reason why that can't be done in the pharmacy and done very adequately.

Um, you know, those are healthcare. Uh, people think of that as a way to improve their health. And, and if you're going to be a healthcare provider, you know, why not bring a misuse into your, into your pharmacy? Why not bring an acupuncturist into your pharmacy? Why not bring a chiropractor into your pharmacy?

Um, you know, all of those kinds of things can fit. Um, and, and you're going to take care of people and you're going to make them live happier, healthier lives. Which is the foundation of the businesses. I see it going forward, happier, healthier lives, 

Mike Koelzer, Host: Bruce, as you look back on your consulting history and actually traveling on the roads and so on, was there a time in your mind where there was a directional shift in your advice to pharmacists?

So think back, let's say 20 years ago, has it been a steady slope of, well, now I'm saying more of this to people and I'm saying less of this or was there ever a time where there was kind of a jump off the 

Bruce Kneeland, BA Mktg & PR: cliff? Yeah, I think it's evolutionary rather than revolutionary. But I will tell you, there was an aha moment that mystified me.

It didn't inspire me. It mystified me. And in that being, in October of 2013, I actually retired. We had the cake and the party and all that kind of stuff. We had been living in Philadelphia. We sold our home and, um, we, we took off on a great adventure to be missionaries for our church. So we, uh, went to Colorado, um, assigned to go there.

We spent 30 months in Colorado. It was a wonderful experience. I disengaged from the industry almost completely and dedicated myself to the ministry, but I still had to go to the pharmacy and, and I can remember going to a little clinic pharmacy in, um, uh, Lakewood, Colorado. And I had to get an ampicillin prescription filled or something like that.

And I'm sitting there [00:25:00] talking to the pharmacist. He had no idea who I was, but, you know, I told him I'd been in the business for awhile. And I asked him a little bit about the ampicillin prescription and he'd actually made 3 cents on that prescription. And I had been freed from that kind of concern about the deterior.

I mean, I would use the AWP minus 12 plus, you know, $2 and 50 cents or whatever. And, when I digested that, you know, he had to transfer the prescription electronically by a label, put the bottle on it, you know, and he made the three, 3 cents. And I just couldn't understand that it was just weird. I'd been in the wholesale drug industry since 1976 and in a, we had gone from.

Uh, if a guy could really buy, well, he would buy at AWP to AWP minus five data BP minus 10 to cost plus three to cost plus, you know, the cost minus. And, I remember a boss of mine telling me once that, you know, this can't possibly go on. You know, at this point in time, we're going to give the drugs away as a wholesaler.

And, and, you know, what's the future here. And, and the point was, you know, if it can't possibly go on it, won't something change. And the wholesalers had to change their business model dramatically, uh, when they got into the cost of minus stuff. And, um, you know, they started going back up channel and charging the, the manufacturers for, uh, services that they provided to the manufacturer in the, the most, uh, Uh, incomprehensible one that we had to bite was we had to get manufacturers to pay us to agree that we wouldn't buy more inventory than we needed, because we were learning to make money on the inflation in the inventory.

So we screwed up the manufacturers by buying, you know, $10 million worth of stuff and holding it and hoping that the price would go up. But, uh, so the wholesalers had to figure out a whole new business model and now the pharmacies have to do the same. 

Mike Koelzer, Host: So, Bruce, you talked about being in Philadelphia, then Colorado, and then you and I spoke about, I don't know, a year ago or something just on the phone, we met each other and so on.

And you had talked about going to Prescott living there because of the climate and things like that. So last week, I'm in Prescott because my brother-in-law lives in Scottsdale. So we went up to Sedona and then to Jerome, and then back down through Prescott. So I'm thinking to myself what a great time that I could pop in.

The crossroads of America's pharmacist's himself bruises. I could pop in on Bruce and give him a dose of his own medicine. You know, I could go in there to press God and tell him what the hell to do with pharmacy, but a day or two before, I'm going to look you up going to Prescott you're off gallivanting in Texas receiving a national pharmacy 

Bruce Kneeland, BA Mktg & PR: award.

Yeah. I'm, I'm proud to say. And thanks for asking. And boy, I wish I had been here. I'd love to take you to lunch on whiskey, row and whiskey row. So yeah, I, um, I was blown away. Uh, it was, uh, invited to go to the American pharmacist association meeting in San Antonio. And, um, there, they were kind enough to give me what they call the honorary membership award.

Um, it is the highest award that they give to a non pharmacist. It's sort of like a lifetime achievement award or whatever. And so it was a wonderful deal. Got to run into a lot of old, old people, old friends. And so, yeah, I, I'm the proud recipient of the 2022 APH, a honorary member 

Mike Koelzer, Host: award.

Congratulations. So you get this award and they say, Bruce, we want you to come up there for three minutes on stage. You've got the audience that you want and you get no BS, three minutes. What kind of stuff are you going to talk about? 

Bruce Kneeland, BA Mktg & PR: Um, don't put me on the spot or anything here. What, what I would drive back to would be heads and tails of the same coin.

Um, Pharmacists need to start talking to people other than pharmacists. And when we do that, 

we need to stop telling them how bad we're being treated. So this is the fatal flaw is nobody cares that you sold a drug under [00:30:00] cost. 

Um, it irritates the bejesus out of you, but you know, if I go to fill my tank up at the shell station and the manager made a mistake and sold it for 2 99, instead of 3 99, I say.

Tough tacos, tortilla face. I'm glad I got the deal. I don't care that you lost a dollar, a gallon. 

Mike Koelzer, Host: That's a Prescott term, by 

Bruce Kneeland, BA Mktg & PR: the way, 

that's for sure. Nobody cares that you're losing money on your prescriptions. They'll 

they'll 

frown with you or whatever, but 

you know, 

they don't care. It's not a motivating factor for them.

It doesn't hurt them. Now, when you go out of business, they might be sorry that you're gone, but they don't care about that. What people care about is that they're getting there, they're getting cheated. Um, and what employers care about is they're getting cheated. So when we start talking to people about how bad things are in pharmacy, we need to be turning that into how bad things are for you.

Sally Jones had to go to the hospital because she didn't get her. Um, that hurts, you know, uh, John CEO, John Jones, uh, spent, you know, a million dollars more on health premiums than he needed to spend because the PBMs were abusing him. We need to show people how, what happens at the counter. Affects them by not showing people invoices and saying, you know, I can't sell it to you because it costs me $50 and good RX once we sell it for 35, that's not the message that we need to take.

So that would be one thing I would talk about in my three minutes. Talk to employers, talk to politicians, talk to school board members, show them how they're being hurt by the way things are happening at the same time. And, and I keep trying to find, uh, an, an analogy that it's not insulting. You and I are old enough, we can read my rule.

We went to a gas station to buy gas and they would sell us gas and they might do oil changes. Um, you go to a gas station now and they've got donuts and hot dogs and soda pop and, uh, route 66 t-shirts and all those other kinds of things as they don't make any money on gas. Um, so they have to find other things to sell.

And, as a pharmacist, you need to figure out what else you can sell. What else can you do to make money? Um, and, and the good news is, there's a thousand things that you can do. So those would be the, the, that would be the crux of what I would try to come up with in three minutes. Plus, I certainly want to throw some boy, am I glad you're there?

I am not a pharmacist. My heart and soul is in the business because I legitimately believe I have been. The recipient of my family has been the recipient of, I legitimately believe that people are better off. If they go to an extremely well-run independent pharmacy, it's a noble cause that I believe in, it's a matter of it.

It's something to be proud of. What, what, what a good independent pharmacy does is beyond remarkable. 

Mike Koelzer, Host: I'm in the audience, listening to your three minute conversation there. Part of the time I'm playing on my phone. No. Anything important, just playing around, catching up on news and things like that. That has nothing to do with who you are, Bruce.

That's just in general. I'm going to be playing on my phone first. When someone gets up to talk, it's their job to pull me off my phone. If they're interesting enough, they'll pull me off my phone. All right. So with your comments there, interesting enough. So I start listening to them and then three thoughts come to my mind.

So one is I'm thinking Jabra is I agreed. 

No one gives a crap. No one cares. When you say you're losing money because they've seen it before on the used car lot. They've seen the used car guy coming out and saying, I'm not gonna be able to feed my family. You don't believe them, maybe you believe them when you find out, for some reason he's not there anymore in the business, you know, God forbid something terrible happened.

Maybe you believe him when he's no longer there. Or like you say, you drive by and the store is closed, but you don't believe it because you've heard it so many times. 

That's number one. The second point is how do you really show [00:35:00] people how terrible it is for them, what the insurance companies are doing without them actually having to change their life.

You can sit and tell them that things are bad for them, but unless they really experience it, they might not really feel it themselves. The third one is it always seems to be pharmacy kind of goes in these ebbs and flows, Bruce, you and I remember the past of independent pharmacies, how they had everything, you know, the soda fountains.

Everything because they weren't making enough profit on their prescriptions. And then maybe for a while there, they would say, get rid of all that non-health stuff. And just focus on the prescriptions, just on the health. You saw that for a while with the medicine shops and things like that. But now you say some of these other stores that have all this other stuff.

It almost feels like we're telling pharmacists, well, go back in and do all this other stuff because your root and your core is not strong enough. So those are my thoughts as I'm listening to you. And then of course, I'm getting ready to give a standing ovation. 

Bruce Kneeland, BA Mktg & PR: It is a dilemma. And, and I, I, I, you know, my, my bias would be health.

I think health is a big enough field, but I will tell you, I'm just going back through some old CE presentations I did in, you know, one of the themes I had a couple of years ago was, you know, run an exceptional pharmacy, but do something else exceptionally well. And, um, what that something else is.

I think for most people it would certainly revolve around health most, most pharmacists simply because that's their inclination, but I don't see any reason why it has to be that way. I remember a very personal experience. I had, my daughter lived in Tulsa, Oklahoma, and she had a baby. And so we went down to see her.

And, uh, my daughter knew nothing about pharmacies or drug stores other than her dad had been involved in her whole life. But when we got there, she said, there's this cute pharmacy, uh, you know, a couple of miles away that you ought to go see, they sell exceptional fudge. And I go down and meet the owner and walk around and chat for a little bit.

And as I'm getting ready to leave, I stand and talk to the fudge lady and some lady comes into the fudge counter and says, somebody told me, you guys make great fudge. The point being is that this guy built a beautiful ground up pharmacy, big DME department, you know, all the classic stuff, uh, robot and, you know, He was also selling fudge.

He wasn't too upbeat. Topsy did not sell fudge. And the fudge brought people in the fudge, had him talk about him and he says he takes fudge when he goes and does his DME doctor detailing. So, um, you know, I think the world is your oyster and whatever you're comfortable with, but do something else exceptionally well that people will talk about.

I hate to say it, but people don't talk about your pharmacy. Um, you know, and unless you're exceptionally personable, 90% of the things that anybody's going to say about your pharmacy is when something went wrong, you're out of stock or the doctor hadn't got the prescription in yet. If you walk into the pharmacy and in charge of the $10 copay and give them the bottle and there's no crossovers on the label and they go home and they get rid of their UTI because the antibiotics work, ain't talkin bout that to anybody.

So you got to have something to talk 

Mike Koelzer, Host: about. You're spot on with that. There's a few reasons why people aren't talking about pharmacy stuff. One is a good pharmacy. If challenged is maybe better than the norm, but in the day-to-day prescription stuff, you're not seeing that from a pharmacist. And then if the pharmacist did their job, the patient's not thinking of their UTI.

Four days later, it's cured. It's not a topic of conversation. Thirdly, you might not want it to be a topic of conversation. You know, it's just not something you necessarily want to talk about. That's why medical equipment has been a little bit easier to market because if a little old lady leaves the pharmacy with this bright flower cane or something like that, I mean, that's a conversation point.

One thing I started doing at my store is. Thousands of these are just [00:40:00] little business cards made up and it just says, you know, we deliver, and please give this to a friend who may need it. And I put one on every prescription because here's the thing. That's not the greatest idea in the world, but because somebody with the UTI doesn't have that flowered cane in front of them, you have to give them something.

That's a quote, a flour cane. You have to give them something to stimulate some of that conversation because it's just not happening. Normal. 

Bruce Kneeland, BA Mktg & PR: Everybody talks about word of mouth. Word of mouth. Word of mouth is absolutely essential. Uh, it's a great form of advertising. It's just that the odds are. Um, most of the things people are going to talk about are disappointing things rather than happy things.

Typically when I'm at a CE program, I'll add the audience, you know, who flew in today for the show. And, you know, 80% of the people will raise their hands and, you know, say, did your plane take off on time? Did it land on time? And did you tell anybody what a great flight it was? And nobody raises their hand and says, who lodged their luggage?

And when poor schmuck raised his hand and said, how many people did you tell you lost your luggage? Um, and that's just the way of human nature. We talk about the exceptional and to be exceptional enough in the positive is exceptional. So when you screw up, that's when people talk about you, the good news is, and this is a trick I learned very early in my life is that if you have that bad experience, if you handle it well, It becomes exceptional.

So for example, somebody walks in and you say, Mrs. Jones, I only have 25. Can't give you all 30 pills today, you know, go ahead and take these home. And when you come back, you know, I'll, I'll, I'll make it up to you. That's fine. That happens all the time. But, but what would happen if when Mrs. Jones got home, she found a phone call from you apologizing again, saying Ms.

Jones. We're so sorry. And if, if you mailed her a voucher for $5 off private label merchandise, Nicks came, she came into the store. Now she's got something to talk about. My pharmacist went above and beyond and he had a problem and he took care of it. Here's 

Mike Koelzer, Host: the pisser of the industry though. People think of community pharmacists, they think of chains and they think of independent pharmacists.

It's my contention that the average chain pharmacist maybe doesn't have the time for that follow-up call. And secondly, they don't even want the person coming back. They're so damn busy. They don't want more of it. Then you go to the independent pharmacists and they're like, I just lost 30 bucks on that brand name, prescription.

And I'm going to call her now and give this double sorrow. I know it's good business, but it just rubs me the wrong way that I'm going to double apologize for something that I lost 30 bucks on. And I don't even really want the damn business. 

Bruce Kneeland, BA Mktg & PR: Mike you, you caught me at I'm back to the old way of thinking is fill more prescriptions, fill more prescriptions, you know, at a, at a feeble attempt to redeem myself.

Um, you know, the, the, the point is, is I say, offer him a coupon for private label merchandise or something that gets them back in the store. And, and so you do want to at least drive that compensation to a portion of the business that is more profitable for you. Um, and then that obviously raises the question, well, what are those businesses that are more profitable?

And, and, you know, there's a handful of them that are reasonably consistently talked about that. I don't know that any of those have yet proven that they can be dramatic. They can be helpful, but not dramatic. I consistently run across people who are making money in this business in growing and happy. So I know it can be done.

All 

Mike Koelzer, Host: right. I get this and I'm trying in the profession. I know you're trying, but as I drive down these streets, you know, and see these corner businesses up for sale and so on. And I come to you and I say, Bruce, I don't think I can open a store up and be successful. Tell me, can I, can you tell people that or as part of it and look of the draw,

Bruce Kneeland, BA Mktg & PR: you know how to ask hard questions, Mike, that's probably why you're so popular. Um, but it's a fair question. I, you know it, I don't know that I have the answer. I can tell you that I see. An exceptionally good [00:45:00] little pharmacy in little rock Arkansas on my last road trip, um, started from scratch and doing well.

And they do a little DME. They do COVID shots. They do, you know, delivery. They, you know, they, they do the classic stuff. They have a nice little boutique, um, you know, so, so it can happen. Perhaps the most striking example is, uh, a pharmacy about, uh, uh, 15 miles north of me. When I moved to Prescott six years ago, there was no independent pharmacy.

Um, a couple of years after I was here, um, a guy opened one in Chino valley. It's about 15 miles north of me. And, it was a guy who was sharp enough to know that there was an opportunity. And very frankly, he did a classic model, but he had been working for a chain for a number of years and the pharmacy was doing eight, 900 scripts a day and just pissing people off.

And he went across the street and opened up a nice modern pharmacy with a drive-through window on a corner location and he's done just fine, um, filling a lot of prescriptions. What he does exceptionally well is he's a very astute manager and a various Stute buyer. So, you know, There's the dichotomy of diversifying and doing other stuff, or there's the opportunity to do it the traditional way, but just be, just be sharp.

Um, you know, he works with his doctors to move people off of prescriptions that he doesn't make any money on. And he watches what he buys and he keeps his staff, you know, I mean it's so yeah, it can be done. I've never been a proponent my whole life of starting from scratch. That's interesting. I've always thought it would be smarter to buy a store and revive it.

I think if you look at the trend of successful, I mean, this is the, this is the, you know, one of the big trends that I don't think gets talked about enough, but, um, The, the number of guys now who loaned 5, 6, 7, 8, 9, 10 stores, um, that they buying up the marginal store in, Roland it in, uh, you know, that's, that's the path forward, I think for the profession in the industry and, and what they do is bring good management principles to that location.

It's a true 

Mike Koelzer, Host: question. It's like, what the hell? I don't know. I don't know if someone came to me, it's like, what do I tell them? But I think that talking to you, buying something that's going, I was listening to a podcast on some apartment investing. I don't do that myself, but it was a pharmacy one. It caught my ear and this guy's goal was to buy apartments.

We're running. They were going, coming in and finding out things that they're not doing. You know, they don't have a little physical fitness area. They don't have a pool, but they've got vinyl countertops instead of granite and so on. But they come in, that's their plan. Come in, turn this stuff around five years later, it's doing better and you've increased the value.

I think that's great advice to try to find a pharmacy that's open. Who's maybe making it by the skin of their teeth and saying, Hey, can I go in there and do something else? 

Bruce Kneeland, BA Mktg & PR: And you know, you come back to classic management things. I spent an hour this morning going through a demo with a guy who's contemplating, launching a company that will help pharmacies buy better.

And you know, the first thing I say to them is, you know, the classic going in up proposition is every pharmacy wants to buy better. So that's an easy, you know, easy conversation. But, you know, he was talking about their market research. Uh, they found out that 70% of the pharmacies don't run a perpetual inventory.

And, you know, that's where I fail. I'm seeing exceptional pharmacies all the time and, you know, run into perpetual inventory and keeping track of the inventory. Just kind of, you know, classic business management. But you, you, you, you've a lot of guys out there just, aren't doing the simple stuff that matters.

And, um, you know, if you can figure out how to take $10,000 off your, off your shelf and run, you turn your inventory from eight to 20 times a year, you can make money on that. 

Mike Koelzer, Host: In that pharmacy. I think that there are some important things that pharmacies can do, like perpetual inventory and marketing and doing some of this stuff.

I think what that does [00:50:00] is. Give a pharmacy a really strong base with the chance then of making it, if they're ingenious, I think it's like, if you don't do the stuff that we talked about here, the basics and the basics now are perpetual inventory and treating your customers well, and that kind of thing. If you're not doing the basics, you don't have a chance in hell of latching onto something unique or something profitable or something niche-y to make it.

The game is like way up there. And then you gotta be better than the game. Even 

Bruce Kneeland, BA Mktg & PR: you have to be better than average. 

Mike Koelzer, Host: Here's what I'm interested in. When you go across the country and you're visiting all these stores, then I know there's some differences in local insurance and things like that. But as you go across these, you're probably like the Bob Seger or journey, any of these bands that have written songs about cities looking the same, you know, you wake up at, uh, I know you're not waking up with a different woman every night, but you might be waking up in a different city, but you hear about all these different cities.

And it seems to me that after a while you see these red brick pharmacies, the windows, they come in, you've got a lot of the stuff. That's the same. It seems to me, one of the things that's not the same is the people running them. And I imagine you run into some people that you kind of scratch your head and say, How'd you get this far, either with incompetence or with anger issues or things like that.

That must be a distinguishing feature that you see as you go across the country. 

Bruce Kneeland, BA Mktg & PR: Yeah, it is the 500 pound gorilla in the room that, you know, is not discussed openly at all. And that is the character, the charisma, the personality of the owner. And, and here's the caveat because I've been watching this for quite some time.

Most pharmacists by definition are detail oriented task oriented people. That's the way they get screened to go into pharmacy school. And boy, am I glad they are? Because the job that they do is tactical detail oriented needs to be very precise. I couldn't do it. I don't have the ability to do that kind of concentration in, in, in detail.

The idea that you find a pharmacist that is a good pharmacist, but then also has the personality to attract and to build a following. Um, you know, that, that, that's an interesting challenge, but the key thing is, is you can hire a person like that. And, um, and, and I think that needs to be, uh, you know, when you're thinking about hiring a technician or a cashier or a front end manager, you need to be looking for somebody who has that magnetic personality and, and, you know, a person who does and who doesn't when you meet them because they have it and you feel it.

And I don't know how to say it any better than that, but personality matters. And if you don't have it, you need to know who you don't have it and you need to hire for it because in a classic independent pharmacy where the commodity is the same and the prices are the same, um, you have to have a competitive edge and that's going to have to be you or the atmosphere and the people in your store.

Mike Koelzer, Host: Speaking about that's your job. Basically, my dad had a pharmacist lady years ago and he'd get pissed behind the scenes at her because she would have her favorite customers. And then she would not respond well or she'd hold a grudge against some people. And my dad ended up firing her. That's not your position.

You're an actor up there. You have to act the part, even if you're not feeling it. I think what you're saying is that some people, if that's not their act at that point, that you can hire in a star and they can do some of that acting for you that maybe you're not up for that month or for whatever. 

Bruce Kneeland, BA Mktg & PR: I'm the youngest of six, my older brother who was out of the house before I was born, was, uh, an actor of some significance in the, um, I can't think of the community theater kind of stuff, live acting all the time.

The point that I referenced from that is you can take a Shakespeare play and you can set all the props up and you can put me in the costume and you can give me the dialogue and I can go out on stage. And forsooth, I know not why, blah, blah, blah. And people are going to boo and hiss. My brother can go out and perform that performance and people will clap and applaud.[00:55:00] 

What's different? The script is the same. The theater is the same. The costumes are the same. It's the performer. And, um, somebody somehow. If you're going to be a superstar in pharmacy, you're going to have to have the ability to have that. 

Mike Koelzer, Host: There just something different about some people 

Bruce Kneeland, BA Mktg & PR: there's it.

And you know, I don't, I don't want to go down too far on that because you either have it or you don't, if you don't have it, you need to know you don't have it and you need to buy it. And if you buy it, that's terrific. Um, you know, there are people who succeed very well in this business by being competent, by being pleasant, not personable.

And then just being able to effectively manage there's a lot of different roles, a lot of different places, um, in, you know, I don't know that there's one pattern for success. And you mentioned it a little while ago. How things have changed and, and there's clearly a change that I, I will hesitate to say, because I know I will offend some important people, but, um, you know, when I started in this business, I started as a medicine shop operations manager and the core behind the medicine shop thing was to create a cookie cutter operation, um, and be able to go out and tell the world that, Hey, I'm, I'm part of a chain that was part of the Stan you, I, you know, hi Mrs.

Jones, this medicine shop is part of a national chain of pharmacies because of that, we can buy better, blah, blah, blah, and all that stuff. And it worked remarkably well for, you know, for many, many years, but, um, you know, then I went to Martin. I tried to get everybody to put up health Mart science. Then he went to the family pharmacy and tried to get everybody to put up family pharmacy signs.

And I think we've come to the point where. Trying to make everybody look like a chain is no longer the answer. I guess that's what I'm trying to say. You need to create a personality. It reflects you and your, and your community. 

Mike Koelzer, Host: One time someone told me, they said to get your store running. Well, pretend like you're a chain of 500 stores.

Just pretend it, you know, get policies in place, treat people like a big operation would not in a negative way, in a positive way. Don't have too much nepotism and don't let the schedule fall apart because someone's, you know, doesn't feel, you know, get some structure to it. Then I think what you're saying is you have to have the right people in line and obviously you have to have the right buying and you have to have the right selling and you have to have everything right.

And on top of all that you kind of have to have the it factor. 

Bruce Kneeland, BA Mktg & PR: You know what you're talking about? That acts like a chain. You know, I've heard it explained two or three different ways, but I think that's what these people are doing that have these 5, 10, 10 store operations. You know, they centralize accounting.

They put everybody on the same pharmacy platform. They buy from the same, you know, from the same places. Um, they have policies and procedures manuals, um, that stuff matters. There's 

Mike Koelzer, Host: so many things that have to come together in the old days. You know, somebody could say, I'm going to school, I'm going to open my pharmacy up and now it's like, it can happen, but you'd better line up all these skills.

Some luck, some passion, some love hard work. I mean, a lot of things have to line up. It can still be done. but a crap load of stuff has to line up. And that's where someone like you comes in, because Bruce you can come in with your consulting and you can say, all right, a hundred things have to line up. Bruce. You might be able to say, I can bring maybe 97 of those to the table, but here's three parts, whatever they are that I can't bring and that sometime is where that balance between failure and success might be in those three things.

Bruce Kneeland, BA Mktg & PR: I love your a hundred things and, and, you know, be fascinated to sit down and try to figure out, you know, create a list of what, you know, 90 of those hundred things would be as we get close to wrapping up here, the message of hope that I'd like to leave is that it can still be done. I know it can still be done because I see people doing it and, and what they're doing.

Is exactly like you say, they're managing to the details exceptionally well. They have, they have routine, USED the details so that they happen virtually automatically, but they didn't happen by accident. And as you go in and watch and observe, you're just seeing the top. It's that, you know, somebody used the phrase the other day: act like a duck, be calm and, and on [01:00:00] the top, but be paid like CAC underneath.

I think all of that paddling like CAC is, is going on underneath and they can then afford to be personable that they can afford to get out and go see doctors. They can join the chamber of commerce. They can run for mayor, uh, and all of that stuff just magnifies its importance, but it only happens when the, when the base is.

You 

Mike Koelzer, Host: gotta be clicking on all cylinders, that 97% of the stuff that better be on fire, that better be moving already. If you're going to be part of that successful group of the people that you come across, 

Bruce Kneeland, BA Mktg & PR: uh, I couldn't have said it better and I love the magical 3%. Uh, you know, that's that, that strikes me as probably the right ratio.

I mean, um, you know, McDonald's is phenomenally successful because every time you go there, you get a hamburger that tastes okay. And it's exactly the same as the other one, for sure. Um, and, and they've mastered the basics and your pharmacy needs to be able to do the same. You need to be able to order, you need to be able to order wisely.

You need to be able to order the right amount. You need to be able to process the, you know, prescriptions rapidly. Uh, you need to have people greeted routes, you know, and that stuff has to happen. And then you can. Um, you know, figure out how I'm going to bring in a new line. I'm going to hire, you know, by a robot or, you know, you can be examining those, those strategic decisions that will set the course forward, be 

Mike Koelzer, Host: creative and work on that small percentage of stuff that maybe the next guy is not going to do.

And that's, I guess maybe where the success is. 

Bruce Kneeland, BA Mktg & PR: Yeah. And I, I'm going to go back to the phrase I used to live. You know, you have to run an exceptional pharmacy and do something else exceptionally well. And whether that's nutraceuticals or compounding or diabetes education or fudge, it just has to be something else there that can create an, an, a personality and environment.

Mike Koelzer, Host: That other thing you're doing. Even if it's not successful, hopefully it is. But even if that other idea's not successful, that's the kind of person you have to beat. You've got to be the person that's thinking of something else, trying to grow, trying to put a new, unique slant on the business and put your personality in there.

All those things kind of come out of that thought process. Even if it's not fully successful, that's the kind of person you need. Who's going to make it in the pharmacy? 

Bruce Kneeland, BA Mktg & PR: And that sets you apart. 

Mike Koelzer, Host: Bruce. I already pulled my ass down to Prescott and you weren't there. Listen, I'm going to make a promise to you. If you come to Michigan, I promise I am not going to be off receiving a national award somewhere.

See how kind I am. You see how rude you can be at how kind I can be. I promise to not be receding that sometime when you're here, 

Bruce Kneeland, BA Mktg & PR: Hey, God bless you. You've got a lot of passion for what you do here. 

Mike Koelzer, Host: It's my little fudge making, I guess. 

Bruce Kneeland, BA Mktg & PR: All right, Bruce, talk to you soon. Thank you.